Don’t Blame it on Aging

Nancy Stiles, MD Associate Professor

Geriatrics Dept of Physical Medicine and Rehabilitation

University of Kentucky

What is Aging?

• Normal Aging • Typical Aging • Age-related disease • Aging is not a disease

Functional Decline

• Common but not normal • A decrease in the ability

to do • Going down hill, frail,

feeble, fatigue, weakness, need for a cane

• Can be physical, mental, emotional, social

• Ageism. Not normal aging

Common Causes of functional Decline

• Dementia • Arthritis • Anemia • Hypothyroidism • Emphysema/COPD • Renal insufficiency • Depression • Medications

Functional Decline

• Often gradual, hard to identify

• Deconditioning with acute illness or injury

• Rehabilitation to address this. Try to return as close as possible to prior level of ability

Avoiding the “Downward spiral”

• Prevention • Comprehensive treatment

for chronic disease • Rehabilitation for decline

associated with acute illness • Identify Early: Can you do everything you

used to be able to do? As easily? As quickly? As

“efficiently”? Are you as happy?

Track your “ability”

Monitor your health

• Weigh regularly • Fluid intake • Exercise – pedometer? • Use a calendar – not just for medical

appointments. Track social events, etc • Short term goals – long term goals • Sleep, pain, anxiety, etc. Look for patterns and

triggers • Happiness/well being • Keep a health log

Treatment of Functional Decline • Identify the root cause • Don’t simply blame it on aging • Pursue a comprehensive evaluation, this may

include referrals to subspecialists, lab work, xrays

• Pursue a comprehensive plan of care, this usually involves consultations with physical therapists, occupational therapists, etc

• If you are home bound, consider Home Health Services for treatment

Osteoarthritis

• Wear and tear arthritis • Be aware of pain in joints

after an activity • Treat early to help

prevent further decline • OT and PT • Optimize body weight

Osteoporosis

• Under diagnosed, especially in men

• Treatment in older adults usually requires more than just calcium and vitamin D

• Vitamin D level

Compression fracture

Compression Fractures and Kyphosis

Feet

• Onychomycosis

Feet

Feet

• Pain in feet • Change in shape of toes and joints • Often hereditary • Podiatrist • Discuss foot wear choices • Treatments can include orthotics,

adjustments to shoes, splints, pads – Not just surgery…

Breathing problems

• Does lung function change with age?

• Asthma • Emphysema, COPD • Tobacco, environmental

exposure • Underdiagnosed • Don’t attribute shortness

of breath purely to aging

Anemia – low blood count

• Anemia is not a part

of aging • Even mild anemia can

cause weakness and cognitive difficulties

• Should have evaluation

Diabetes Type II Diabetic education Association with body

weight Underdiagnosed Misconceptions – no

sweets, inevitable, runs in the family, diet

Complications

Neurologic Problems

• Cerebrovascular disease • Strokes: large and small blood vessels • TIA’s stroke symptoms that completely

reverse - including memory • Rehabilitation • Hospitals with stroke centers

Dementia, Memory Disorders

• Memory loss vs memory lapse • Not just memory! Judgment, insight,

visual-spatial ability, etc • All humans have some memory loss, but

significant decline is not “normal aging” • Evaluation • Treatment

Dementia, Memory Disorders

• Mild cognitive impairment • Alzheimer’s disease • Vascular dementia • Lewy Body Dementia

Falls

• Often multifactorial • Vision • Walking ability • Weakness/functional

decline • Medication side effect • Environment • Bad luck

Falls

• Thorough evaluation – physical exam, lab tests, xrays

• Physical Therapy • Occupational Therapy

Insomnia

• Not normal aging • Avoid sleeping

medication • Melatonin • Day time napping • Morning sunlight • Exercise • Sleep study

Sleep apnea

• Underdiagnosed • Equipment more

refined and better tolerated

• Weight loss • Can effect brain

function • Relationships

Depression

• Common • Loss of friends, family,

health, home. Coping skills

• Therapist to help identify root cause

• Rarely will treat with just a medication

• “What makes you happy” • Always watch for suicidal

and homicidal thoughts

Urinary incontinence

• Toileting diary • Kegel exercises • Fluid intake • Diuretic schedule • Medications for urinary incontinence– but

these have side effects • Consultations with urologist or

gynecologist

Medications

• Avoid when you can – especially for medications that only treat symptoms

• Often best to “start low and go slow” with dosing

• Ask what else other than medications can be done to treat a condition

• At each visit, ask if your medications are still needed or could be reduced

Medications

• Allergies – may be able to use a crème (such as Benadryl crème) or nasal spray (Astelin)

• High blood pressure – may need more than one medicine. Ask at what times these medicines should be taken. Two low dose medicines may have fewer side effects than one higher does.

• Ask about “topical” (patches and ointments applied to the skin) medications

Medications

• Diurectics (fluid pills) – if on more than one dose a day, check to see when the second dose can be taken. Avoid taking close to bed time. Ask how the diuretic may need to be adjusted or monitored if you develop an acute illness

Medications

• Medications for insomnia, anxiety, and pain often have significant side effects – which a person may not be aware that they are having.

• Ask how you might be able to manage these conditions without or on less medications.

• Acid Reflux – discuss nonmedication management strategies

• Always discuss with your health care provider before discontinuing or reducing a medication!

Don’t Blame it on Aging